Breast Surgeon Visit, Cancer Work-up

Warning: If you have issues with medical terms and descriptions, please skip this post.  I also mention breast-related female anatomy terms.  This post is very detailed and intended for other women out there who may be facing the same scary situation.

Today was my appointment with the breast cancer surgeon over at the Christ Hospital Cancer Center.  Since Nathan was sick the night before, it was decided that C would stay at home with him while I drove myself to the appointment.  So I did.

I pulled up into the VIP slots in the parking garage denoted with signs saying, “Cancer Patients Only.”  I watched a woman, perhaps in her early 50’s, as she too parked in the special parking place.  As I attempted to shoot C a quick text message saying that I had arrived at the Center, I watched as the woman slowly limped along with her cane into the building.  The sign and the woman served as a reminder that this tiny little lump is serious business.

I hopped out of my SUV and headed on in.  I passed by a wall with a collage of names, like a memorial wall of sorts. I was horrified, I mean why on earth would a Cancer Center hang up all of their deceased patients’ names for current patients to see?  I took a closer look, briefly, and realized that it was actually a list of honorable staff, thank goodness, and not a noteworthy case of public relations gone bad. I found my way to the sign-in desk, where I met the first of many very friendly, positive staff members at the Cancer Center.  She smiled sweetly and pointed me to another office where another kind soul waited for me.  I went in and sat down by the woman’s desk.  I noticed that she had one of those cute pinky fingers that curved in a hyper-extended fashion, like little kids sometimes have. She gathered the necessary insurance information and placed a hospital bracelet on my wrist.  This alarmed me, and I mentioned that I was just there for a check-up, nothing more, so did I really need to wear this bracelet? Turns out I did, as does everyone who is seen there.  She then asked me to take a seat in the Resource Room and to help myself to food and coffee,  so I did.

I walked into the room and looked around.  The room was a good size with half glass walls on most of the walls, very modern and tranquil.  There was a huge, beautiful salt-water bow-front fish aquarium complete with brightly colored exotic fish and a full array of corals and stationary invertebrates.  It reminded me of the movie, “Finding Nemo” because they had a fish of the same species as Dora. The walls were lined with row after row of cancer-related pamphlets, living will information, pain control, and hospice care. I tried not to look at those. Instead, I went into their refreshments room and helped myself to coffee and fig newton snacks. I found myself feeling dazed and focused all at the same time.  I focused on insignificant details, like which flavor of coffee creamer to add to my drink, and if this particular cup would taste better with one sugar or two.

An older man with a hunched back entered the small room and so I quickly added two packs of sugar and headed back into the Resource Room.  The coffee was too sweet- one packet would have sealed the deal.

A dazed-looking 30-ish year old woman sat adjacent to me. We did not look at each other, and if she did look at me, I am not so sure that she even noticed me.  She had long hair, it was not a wig, so I assumed she was probably a new patient.  I looked around the room at the other patients. A few older women were on the computers in the room. They had hats on but looked fine to me.  A few patients leaned heavily on canes or their spouses way before their time. A blonde-headed lady glanced my way and smiled, which I returned, but she was too far away to attempt conversation. So I mostly just sat and waited, sipping my too-sweet coffee and making a total mess of my fig newton cookie.  I grew bored after a few minutes and longed for my Kindle to read, or that my iPhone would have service in the bowels of the hospital. I had neither, and recalled a game my brother and I used to play with Fig Newtons cookies.  We would break off a piece, then smoosh the sticky ends together and hold it upright. Whoever had the longest-standing cookie won the game.

Fifteen minutes passed. Another friendly face came and got me to take me back to the examining room.  The lady was cheery and said, almost to herself, “They told me to look for ‘that pretty little thing’ to find you and Ooop! There you are!”

I popped the rest of the cookie into my mouth and gathered my things to follow her.  Then disaster happened: My cochlear implant beeped two times, signaling that the batteries were about to go out.  Seriously? Now? My stupid batteries were going to go out now and leave me unable to understand the surgeon who I have waited two weeks to see?!? I found a pack of batteries in my purse and was hopeful for a second, which deflated as soon as I saw that there were only two batteries in the pack and I needed three.  I decided to just turn it off to save any remaining battery left, and then turn it on once the surgeon was in the room.

A super-sweet nurse came in and I explained my hearing situation. Thankfully, she was very easy to lipread. Something amazing happened next- the nurse actually started calling around to see if anyone could fetch me a battery for my cochlear implant! Talk about going the extra mile. Anyhow, she gathered detailed information about my family history of cancer, my medical history, and finally the details of my tumor.  I told her everything that I could possibly recall. She took my vitals and then left to report to Dr. Jennifer, my surgeon. A short time later, Dr. J came into the room and I was shocked at what I saw. She was maybe 32 years old, just a few years older than myself and tall with curly hair. She offered me a firm handshake with a genuine smile and I decided right then and there that I really like her.  The rest of the appointment, she was personable and friendly, very warm and honest with me.  The super-sweet nurse (S) attended Dr. J during my evaluation.

I repeated my history and she performed a manual breast exam.  She focused on the left breast and the tumor, but had thoroughly checked my right one and under-arm area as well as my neck and collar bone areas. She laid me back on the table and felt the tumor.  I showed her the newborn tumor and she said that it was very small.  I mentioned that the left breast feels differently from my right in general, she strongly agreed with me, saying words like “lumpy” and “dense tissue.”  After feeling the tumors and viewing my ultrasound pictures, I asked her if she agrees with the 90% benign offered by the radiologists.  She danced around it, not offering a number but saying that although the tumor looks benign, it is not behaving like a benign growth based on my history and recent developments.  I asked if she could give me an 80% percent benign estimate, she frowned but decided to give me that number.  Hope is a powerful thing. She was honest with me, and I liked that regardless of outcome.

She said she wanted to do the core needle biopsy right then and there. I felt very nervous because it was unexpected and so I did not have any time to mentally prepare for it. I changed into a gown that opened in the front and huddled in the warm blanket that the nurse offered me.  A table filled with biopsy equipment was wheeled in behind her.  She explained the process as I layed back on the table and injected me with lidocaine to numb the area. It burned a little, about like a brief wasp sting.  I focused on the black speckled ceiling tiles above me, searching for patterns before deciding to just count them.

One, two, three, I thought to myself as she then took a scapel and made a small cut above the tumor.

Four, Five, Six…I felt an odd tugging sensation followed by a sharp prick when she sliced an area not numbed.  She apologized and S, the nurse, offered me her hand and rubbed my shoulder comfortingly.

Seven, eight, nine…Dr. J then took the actual needle-gun and placed it above the tumor.  She shot the needle into the tumor with an audible click and I felt a little burning and stinging where it had punctured me. I instinctively jumped a little. She pulled the needle out which was trailed by a two inch long sliver of biopsy material, presumably a cross-section of the actual tumor. I was relieved when it was done. It was much more simple and painless than I had expected. I was glad the worse was over.

Then she said that she wanted to get one more sample.

My body came to the rescue and started to bleed. Profusely. A lot like a stuck pig in fact. I soaked through a handful of gauges while she applied firm pressure to the wound.  I kept on bleeding. I asked her if it was due to what I thought was increased blood flow/vessels on the sonogram image of the tumor.  She smiled and said, “Yes, it indeed does…and I just hit a big one.”  She explained that excessive bleeding is very rare, that I was just the “lucky patient.”  I kept bleeding for a few more handfuls of gauges and finally the stinker behaved itself and clotted the vessel. She decided the lone sample would be enough.

She said that she wanted to test me for specific breast cancer gene mutations, because my mother had tested positive.  She wanted to check my prolactin levels, the hormones responsible for milk production. My history strongly supports the symptoms of a pituitary tumor.  After reading the list of symptoms, I can see that the diagnosis would explain quite a bit- everything from my inability to conceive to my heart issues to the fact that my milk factories started operations before a pregnancy and had never really stopped.

The problem is that I will have to do an MRI with contrast.  To have this done, I have to have small magnets removed from just under my skin where my cochlear implants are. I would have done it today but the only surgeons who are willing to touch cochlear implants were both out of town. Plus, they would have to give me Benadryl to prevent possible allergic reaction to the dye and I would need a ride home to avoid a DUI of sorts. Fine with me. We planned to do the magnet excision and MRI scan next week, TBA.

Warning: graphic info ahead…

Next, she wanted a mammogram. So S the nurse and I walked over to the Woman’s Imaging Center.  Let me just say that I do not understand why women are terrified of mammograms. While it is a little uncomfortable, they only squeeze the breast for a brief moment while they snap the picture. However, I had just had a biopsy done and they had to squish my girls into impossible shapes, think ‘pancake’ and you get the idea. Then things got gross. It turns out that the biopsy needle had also punctured a milk duct or two, so when they squeezed the breast, it was blood instead of milk that came out.  I was alarmed as the blood puddled on the x-ray platform before threatening, seriously, to fall onto my shoes below. Gross.

I chatted with the mammogram nurse, who was sweet (see a pattern here?) and talkative in a warm, reassuring manner. She shared with me story after story and I gasped and ooo-ed and wow-ed in response while trying my best to stand still and keep my chin out of the way of the picture.  There was pretty much no way to avoid the awkwardness of standing in a cold room topless with a stranger, so talking was a welcomed distraction.  I handled it like a pro.

She told me stories about how her mom valiantly fought breast cancer and won, only to die of lung cancer shortly after because she refused to give up smoking. She told me a story of a young woman who got married and moved off with her fiance, and was diagnosed with breast cancer six months after their wedding. The new husband told this woman that “he didn’t sign up for this (cancer)” and left her. The nurse and I talked animatedly about the disgraced husband’s future seat in hell, with dreamy smiles on our faces. Turns out that the woman’s story had a happy ending.  She beat cancer and remarried later on to a wonderful man. Good riddance, as far as we were concerned.

After the mammogram, which the radiologists said that he could see the nodule but it was inconclusive, I headed back over to the Cancer Center for the blood draw.  A lady sat in the small waiting area near me. I was shocked at how beautiful she appeared and told her how beautiful she looks.  She was flattered and we struck up a conversation. Turns out that she has breast cancer and I immediately recognized the post-chemo glow.  I’m not talking about from radiation. I mean that every single patient, including my mom and grandmother, once their hair grows to around 3 inches, they look more beautiful than ever. Honest injun.  I think it has something to do with changes at the cellular level, and I guess it is just an unexpected blessing, like a new start after chemo. She also had a radical mastectomy with reconstruction, and said she would do it again in a heartbeat. She was proud of her perky new girls. It was just the two of us, so we spoke openly and she stuck out her chest to display her perky new girls, her trophy from her battle with cancer.  After the last needle puncture, I was sent on my way to await further instructions regarding more tests and to wait on my pathology (biopsy, mutation tests, hormone tests) results.

I came home with a massive headache. Hugged my handsome boys and laid down to rest.